Pathology of Glomerular Disease Flashcards
what is a podocyte
a cell in the bowman’s capsule that wraps around the capillaries
proteins equal to and bigger/smaller than albumin will not be filtered at glomerulus
bigger
layer that capillary endothelium lies on
basal lamina
3 layers of glomerular membrane
endothelium, basal lamina and podocyte foot process
what is a podocyte foot process
a projections of the podocyte cell that wrap around the capillary and leave slits between
what are mesangial cells
group of cells which support capillaries
what do the mesangial cells make up
the mesangium
glomerulonephritis is inflammatory/non-inflammatory
can be either
some glomerulonephritis can be due to the deposition of
immunoglobulins
what is glomerulonephritis
a large range of diseases of the glomerulus
someone presents with discoloured urine with dipsticks positive for blood. What investigations should be done
urine culture and ultrasound, then biopsy if nothing found
how does IgA deposition cause nephropathy
IgA clogs the mesangium –> irritates the cells –> causes them to proliferate –> excess mesangial cells
IgA nephropathy is inflammatory/non-inflammatory
inflammatory
presentation of IgA nephropathy
- blood in urine
- flank pain
- hand/feet oedema
- hypertension
outcomes of IgA nephropathy
usually self-limiting and resolves
small amount of continued deposition –> glomerulus becomes more sclerosed –> chronic renal failure
in membranous glomerulonephritis where does IgG get stuck
between basal lamina and podocyte of glomerulus
pathophysiology of membranous glomerulonephritis
IgG accumulates between basal lamina and podocyte –> activates C3 (complement) –> punches a hole in filter –> leaky filter lets albumin through –> nephrotic syndrome
what would you expect to find in a blood test for membranous glomerulonephritis
low serum albumin
what would you expect in urine of membranous glomerulonephritis
high albumin in urine (proteinuria)
what is the membrane like in membranous glomerulonephritis
thickened and leaky
what causes IgG production and accumulation in membranous
essentially unknown - can be malignancy
presentation of membranous glomerulonephritis
proteinuria, feeling unwell, ankle and leg oedema, low serum albumin, weight gain
why do a clotting screen before a renal biopsy
because bleeding is a big risk of a kidney biopsy so you want to make sure this isn’t likely
pathophysiology of diabetic nephropathy
high blood glucose –> glycated molecules –> deposition in basal lamina and mesangial matrix –> thickened and leaky membrane and mesangium compressing capillaries
consequence of diabetic neuropathy on glomerular circulation
compressed capillaries and thickened, narrowed arterioles –>
name given to excess growth of mesangial matrix in diabetic nephropathy
nodules - kimmelsteil-wilson lesion
expected findings of blood test in diabetic nephropathy
low albumin (all leaking into urine)
rapidly rising creatinine is a sign of what
acute renal failure
what investigations would you do in suspected acute renal failure (rapidly rising creatinine)
ultrasound and renal biopsy
histology of crescentic glomerulonephrititis
influx of macrophages forming crescent around glomerulus
what is wegeners
a type of vasculitis which affects kidnyes, nose and lungs
in kidnyes it presents as crescentic glomerulonephritis
tests for wegeners
serum test for anti neutrophil cytoplasmic antibodies (ANCA)
what are anti-neutrophil cytoplasmic antibodies
antibodies directed against proteinase 3 and myeloperoxidase (enzymes in primary granules of neutrophils)
effect of ANCA on kidneys
damage endothelial tissue
